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Role of left atrial hypertension in pulmonary hypertension associated with bronchopulmonary dysplasia
Left atrial hypertension (LAH) may contribute to pulmonary hypertension (PH) in premature infants with bronchopulmonary dysplasia (BPD). Primary causes of LAH in infants with BPD include left ventricular diastolic dysfunction or hemodynamically significant left to right shunt. The incidence of LAH,...
Autores principales: | , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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Frontiers Media S.A.
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9615143/ https://www.ncbi.nlm.nih.gov/pubmed/36313896 http://dx.doi.org/10.3389/fped.2022.1012136 |
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author | Sullivan, Rachel T. Tandel, Megha D. Bhombal, Shazia Adamson, Gregory T. Boothroyd, Derek B. Tracy, Michael Moy, Amanda Hopper, Rachel K. |
author_facet | Sullivan, Rachel T. Tandel, Megha D. Bhombal, Shazia Adamson, Gregory T. Boothroyd, Derek B. Tracy, Michael Moy, Amanda Hopper, Rachel K. |
author_sort | Sullivan, Rachel T. |
collection | PubMed |
description | Left atrial hypertension (LAH) may contribute to pulmonary hypertension (PH) in premature infants with bronchopulmonary dysplasia (BPD). Primary causes of LAH in infants with BPD include left ventricular diastolic dysfunction or hemodynamically significant left to right shunt. The incidence of LAH, which is definitively diagnosed by cardiac catheterization, and its contribution to PH is unknown in patients with BPD-PH. We report the prevalence of LAH in an institutional cohort with BPD-PH with careful examination of hemodynamic contributors and impact on patient outcomes. This single-center, retrospective cohort study examined children <2 years of age with BPD-PH who underwent cardiac catheterization at Lucile Packard Children's Hospital Stanford. Patients with unrepaired simple shunt congenital heart disease (CHD) and pulmonary vein stenosis (only 1 or 2 vessel disease) were included. Patients with complex CHD were excluded. From April 2010 to December 2021, 34 patients with BPD-PH underwent cardiac catheterization. We define LAH as pulmonary capillary wedge pressure (PCWP) or left atrial pressure (LAP) of at least 10 mmHg. In this cohort, median PCWP was 8 mmHg, with LAH present in 32% (n = 11) of the total cohort. A majority (88%, n = 30) of the cohort had severe BPD. Most patients had some form of underlying CHD and/or pulmonary vein stenosis: 62% (n = 21) with an atrial septal defect or patent foramen ovale, 62% (n = 21) with patent ductus arteriosus, 12% (n = 4) with ventricular septal defect, and 12% (n = 4) with pulmonary vein stenosis. Using an unadjusted logistic regression model, baseline requirement for positive pressure ventilation at time of cardiac catheterization was associated with increased risk for LAH (odds ratio 8.44, 95% CI 1.46–48.85, p = 0.02). Small for gestational age birthweight, sildenafil use, and CHD were not associated with increased risk for LAH. LAH was associated with increased risk for the composite outcome of tracheostomy and/or death, with a hazard ratio of 6.32 (95% CI 1.72, 22.96; p = 0.005). While the etiology of BPD-PH is multifactorial, LAH is associated with PH in some cases and may play a role in clinical management and patient outcomes. |
format | Online Article Text |
id | pubmed-9615143 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | Frontiers Media S.A. |
record_format | MEDLINE/PubMed |
spelling | pubmed-96151432022-10-29 Role of left atrial hypertension in pulmonary hypertension associated with bronchopulmonary dysplasia Sullivan, Rachel T. Tandel, Megha D. Bhombal, Shazia Adamson, Gregory T. Boothroyd, Derek B. Tracy, Michael Moy, Amanda Hopper, Rachel K. Front Pediatr Pediatrics Left atrial hypertension (LAH) may contribute to pulmonary hypertension (PH) in premature infants with bronchopulmonary dysplasia (BPD). Primary causes of LAH in infants with BPD include left ventricular diastolic dysfunction or hemodynamically significant left to right shunt. The incidence of LAH, which is definitively diagnosed by cardiac catheterization, and its contribution to PH is unknown in patients with BPD-PH. We report the prevalence of LAH in an institutional cohort with BPD-PH with careful examination of hemodynamic contributors and impact on patient outcomes. This single-center, retrospective cohort study examined children <2 years of age with BPD-PH who underwent cardiac catheterization at Lucile Packard Children's Hospital Stanford. Patients with unrepaired simple shunt congenital heart disease (CHD) and pulmonary vein stenosis (only 1 or 2 vessel disease) were included. Patients with complex CHD were excluded. From April 2010 to December 2021, 34 patients with BPD-PH underwent cardiac catheterization. We define LAH as pulmonary capillary wedge pressure (PCWP) or left atrial pressure (LAP) of at least 10 mmHg. In this cohort, median PCWP was 8 mmHg, with LAH present in 32% (n = 11) of the total cohort. A majority (88%, n = 30) of the cohort had severe BPD. Most patients had some form of underlying CHD and/or pulmonary vein stenosis: 62% (n = 21) with an atrial septal defect or patent foramen ovale, 62% (n = 21) with patent ductus arteriosus, 12% (n = 4) with ventricular septal defect, and 12% (n = 4) with pulmonary vein stenosis. Using an unadjusted logistic regression model, baseline requirement for positive pressure ventilation at time of cardiac catheterization was associated with increased risk for LAH (odds ratio 8.44, 95% CI 1.46–48.85, p = 0.02). Small for gestational age birthweight, sildenafil use, and CHD were not associated with increased risk for LAH. LAH was associated with increased risk for the composite outcome of tracheostomy and/or death, with a hazard ratio of 6.32 (95% CI 1.72, 22.96; p = 0.005). While the etiology of BPD-PH is multifactorial, LAH is associated with PH in some cases and may play a role in clinical management and patient outcomes. Frontiers Media S.A. 2022-09-20 /pmc/articles/PMC9615143/ /pubmed/36313896 http://dx.doi.org/10.3389/fped.2022.1012136 Text en Copyright © 2022 Sullivan, Tandel, Bhombal, Adamson, Boothroyd, Tracy, Moy and Hopper. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. |
spellingShingle | Pediatrics Sullivan, Rachel T. Tandel, Megha D. Bhombal, Shazia Adamson, Gregory T. Boothroyd, Derek B. Tracy, Michael Moy, Amanda Hopper, Rachel K. Role of left atrial hypertension in pulmonary hypertension associated with bronchopulmonary dysplasia |
title | Role of left atrial hypertension in pulmonary hypertension associated with bronchopulmonary dysplasia |
title_full | Role of left atrial hypertension in pulmonary hypertension associated with bronchopulmonary dysplasia |
title_fullStr | Role of left atrial hypertension in pulmonary hypertension associated with bronchopulmonary dysplasia |
title_full_unstemmed | Role of left atrial hypertension in pulmonary hypertension associated with bronchopulmonary dysplasia |
title_short | Role of left atrial hypertension in pulmonary hypertension associated with bronchopulmonary dysplasia |
title_sort | role of left atrial hypertension in pulmonary hypertension associated with bronchopulmonary dysplasia |
topic | Pediatrics |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9615143/ https://www.ncbi.nlm.nih.gov/pubmed/36313896 http://dx.doi.org/10.3389/fped.2022.1012136 |
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